Clinical profile of steroid-induced glaucoma in Bali Mandara Eye Hospital year 2019

Introduction: Glaucoma is an optic neuropathy characterized by optic disc cupping and visual field loss usually associated with raised intraocular pressure. Glaucoma incidence is rapidly increasing, with global incidence is estimated to reach 76 million in 2020. There are many causes of glaucoma; one of them is corticosteroid use. Unmonitored steroid use can be resulting in undesirable side effects such as steroid-induced glaucoma. This study aims to evaluate the clinical profile of steroid-induced glaucoma in Bali Mandara Hospital year 2019.

Method: A descriptive-cross sectional study was conducted using secondary data involving 35 medical records of patients diagnosed with glaucoma in Bali Mandara Eye Hospital, Denpasar, from January to December 2019. Age, gender, steroid type, routes and duration of steroid administration were recorded from medical records. Obtained data were analyzed descriptively using SPSS version 23 for Windows.  

Results: Patient’s characteristics mostly were male 57.14% and 42.86% female, 31.43% were elderly >55 years old. They mostly used eye drops steroid (85.71%), and 14.29% took oral steroids. The most used eye drops were Dexamethasone eye drops (77.14%). For oral steroids, they took Methylprednisolone (8.57%) and Dexamethasone (5.71%). Most of them have symptoms after one year of steroid use (34.39%).

Conclusion: Steroid-induced glaucoma can occur in both males or females in all age groups, which the elderly and children have a higher risk. Most cases occur from topical steroids. Steroid-induced glaucoma is avoidable irreversible blindness. Therefore, the use of steroids must be judicious; self-medication must be avoided. The doctor must provide education to patients who are given steroid therapy.

Nilai diagnostik dari mean platelet volume (MPV) pada sepsis neonatorum di RSUD Wangaya, Denpasar, Bali, Indonesia

Background: Neonatal sepsis is a clinical syndrome of systemic disease with high morbidity and mortality. Early diagnosis of neonatal sepsis is still difficult to be done. A cheap, fast, and accurate septic marker is needed. Several studies of mean platelet volume have been done and are considered as one of the markers that can help diagnose neonatal sepsis early and accurately. The objective of this study is to assess the diagnostic value of MPV in neonatal sepsis.

Methods: This analytic observational study with the diagnostic test was done by collecting secondary data from medical records of neonates with suspicion of neonatal sepsis in Wangaya Hospital, Denpasar, from January 2019 to June 2020.  MPV cut-off point was determined with receiver-operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MPV in neonatal sepsis were determined using a 2x2 table.

Results: Of 104 sample subjects, 16 subjects (15.4%) were diagnosed with neonatal sepsis. MPV with a cut-off point of 9.95 fl had 62.5% sensitivity, 61.4% specificity, 22% PPV, 90% NPV, and 61% accuracy.

Conclusion: MPV with a cut-off point of 9.95 fl can be used to diagnose neonatal sepsis with a 62.5% sensitivity and a 61.4% specificity.

Latar Belakang: Sepsis neonatorum merupakan sindrom klinik penyakit sistemik yang memiliki angka morbiditas dan mortalitas yang tinggi pada neonatus. Diagnosis sepsis neonatorum masih sulit dilakukan dengan cepat. Diperlukannya alat penanda sepsis yang murah, cepat, dan akurat. Beberapa penelitian mengenai mean platelet volume (MPV) telah dilakukan dan salah satu pilihan pemeriksaan yang diharapkan dapat membantu penegakan diagnosis sepsis neonatorum dengan cepat dan akurat. Tujuan penelitian ini adalah untuk mengetahui nilai diagnostik dari MPV pada sepsis neonatorum.

Metode: Studi observasional analitik dengan uji diagnostik ini dilakukan dengan mengumpulkan data sekunder dari rekam medis neonatus yang dirawat di RSUD Wangaya, Denpasar dengan kecurigaan sepsis neonatorum dari Januari 2019 hingga Juni 2020. Titik potong nilai MPV akan ditentukan menggunakan kurva receiver-operating characteristic (ROC). Nilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), dan akurasi dari nilai MPV pada sepsis neonatorum akan ditentukan menggunakan tabel 2x2.

Hasil: Dari 104 subjek sampel, didapatkan subjek dengan diagnosis sepsis neonatorum sebesar 16 subjek (15.4%). Dengan titik potong MPV sebesar 9,95 fl, didapatkan nilai sensitifitas 62,5%, spesifisitas 61,4%, NDP 22%, NDN 90%, dan akurasi 61%.

Kesimpulan: MPV dengan titik potong 9,95 fl dapat mendiagnosis sepsis neonatorum dengan sensitifitas 62,5% dan spesifisitas 61,4%.

Asam urat serum tinggi dan risiko mortalitas kardiovaskular: sebuah tinjauan sistematik penelitian kohort

Introduction: Serum uric acid has been reported as a predictor of cardiovascular mortality, but there are many debates regarding this finding. This systematic review will analyze and discuss about serum uric acid as an indicator of cardiovascular mortality risk.

Methods: A literature search was carried out on the PubMed and ProQuest databases for publication that focused on the association of serum uric acid and cardiovascular mortality risk within 2015-2020. The preparation of this systematic review is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA).

Results: In this review, four studies were relevant and met the selection criteria. All studies were prospective cohort studies. There were a total of 668,768 participants involved, with a slight female majority (55%). Participants involved in this study were aged 35 years or older. Three of the studies examined showed an association between high serum uric acid levels and cardiovascular disease mortality. Only one study did not show a statistically significant relationship. Each study used a different cut-off point for serum uric acid categories, making the uric acid indicator difficult to apply in clinical practice. The three studies conducted in Asia provide a more practical result that is relevant to the Indonesian population. In all three studies, results were consistent, showing elevated serum uric acid increases cardiovascular mortality risk.

Conclusion: Serum uric acid level can predict the risk of death from cardiovascular disease. The study conducted in Asia is quite relevant to the Indonesian population, where the results of the study significantly and consistently found that high serum uric acid levels can increase the risk of cardiovascular mortality.  

Pendahuluan: Asam urat serum dilaporkan dapat memperkirakan risiko dari mortalitas kardiovaskular, akan tetapi masih terdapat banyak perdebatan terkait temuan tersebut. Dalam tinjauan ini akan dibahas lebih jauh mengenai hubungan asam urat serum terhadap risiko mortalitas kardiovaskular yang disajikan dalam systematic review.

Metode: Pencarian literatur dilakukan pada database PubMed dan ProQuest dengan mengidentifikasi jurnal yang diterbitkan dari tahun 2015-2020 yang berfokus pada topik asam urat serum dan hubungannya terhadap risiko mortalitas kardiovaskular. Penyusunan systematic review ini disusun berdasarkan pedoman Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA).

Hasil: Dalam tinjauan ini terdapat 4 studi yang relevan dan memenuhi kriteria seleksi. Seluruh studi merupakan studi kohort prospektif. Terdapat total 668.768 partisipan yang terlibat dengan persentase perempuan sebesar 55%. Partisipan yang terlibat dalam studi ini berusia 35 tahun atau lebih. Tiga dari empat penelitian yang ditinjau menunjukan adanya hubungan antara kadar asam urat serum yang tinggi dengan kematian akibat penyakit kardiovaskular. Hanya satu penelitian yang tidak menunjukan hubungan yang bermakna secara statistik. Masing-masing penelitian menggunakan titik potong kategori asam urat serum yang berbeda-beda yang menyebabkan efektivitas indikator asam urat serum sulit untuk diaplikasikan. Tiga studi yang dilakukan di Asia memberikan gambaran yang lebih sesuai untuk aplikasi di Indonesia karena populasi partisipannya lebih mendekati keadaan populasi Indonesia.  Pada ketiga studi tersebut diperoleh hasil yang konsisten menunjukan peningkatan asam urat serum meningkatkan risiko mortalitas kardiovaskular.

Kesimpulan: Kadar asam urat serum dapat dapat memperkirakan risiko mortalitas akibat penyakit kardiovaskular. Studi yang dilakukan di Asia, cukup relevan dengan populasi Indonesia, dimana hasil studi ini secara signifikan dan konsisten mendapatkan kadar asam urat serum yang tinggi dapat meningkatkan risiko mortalitas akibat penyakit kardiovaskular.

Hubungan antara terapi statin dengan kadar gula darah puasa dan profil lipid pada pasien coronary artery disease di RSUD Sanjiwani

Background: Statin therapy has an important role to coronary artery disease (CAD) which can lowered cholesterol levels and give pleiotropic effects to inhibit inflammatory reactions. Statin have some side effects and new onset diabetes is one of them, where diabetes is also a risk factor for CAD. This study aims to know the correlation of statin therapy and fasting blood glucose levels of CAD patient in Sanjiwani Hospital.

Methods: The design of this study was analytic cross-sectional study that started from November 17th 2020 until January 31st 2021 in Sanjiwani Hospital. A total of 68 patients were included in this study. The data source of this study was secondary data from patient’s medical record. The inclusion criteria was all CAD patients with statin therapy who had history of fasting blood glucose test that visited cardiology department of Sanjiwani Hospital at year 2020. Normality test, bivariate, and multivariate analysis was done in this study.

Results: Bivariate analysis using Spearman showed a weak positive correlation between duration of statin therapy with fasting blood glucose levels (r=0,353; p= 0,003), and Kruskal Wallis analysis showed no correlation between statin type with fasting blood glucose levels.

Conclusion: Duration of statin therapy has a weak correlation with fasting blood glucose levels so that statin still can be given with concerns to its benefit of reduced mortality. Prevention of new onset diabetes should be done by lifestyle modification and periodic blood glucose monitoring.

Latar Belakang: Terapi statin memiliki peranan penting terhadap coronary artery disease (CAD) yang mampu menurunkan kadar kolesterol serta memberikan efek pleiotropik untuk menghambat reaksi inflamasi. Statin memiliki beberapa efek samping, salah satunya adalah risiko diabetes onset baru dimana diabetes merupakan salah satu faktor risiko CAD. Penelitian ini dilakukan untuk mengetahui hubungan antara terapi statin dengan kadar gula darah puasa pasien CAD di RSUD Sanjiwani.

Metode: Desain penelitian yang digunakan adalah analitik cross-sectional yang dilakukan dari 17 November 2020 sampai 31 Januari 2021 di RSUD Sanjiwani. Sebanyak 68 pasien diikutkan dalam penelitian ini. Sumber data pada penelitian ini berupa data sekunder yang didapatkan dari rekam medis pasien dengan kriteria inklusi yaitu semua pasien CAD dengan terapi statin dan memiliki riwayat pemeriksaan kadar gula darah puasa yang melakukan kontrol di poli jantung RSUD Sanjiwani tahun 2020. Uji normalitas, analisis bivariat, dan multivariat dilakukan pada penelitian ini.

Hasil: Analisis bivariat dengan Spearman menunjukan adanya korelasi positif lemah antara durasi terapi statin dengan kadar gula darah puasa (r=0,353; p= 0,003), sedangkan hasil analisis Kruskall Wallis menunjukan tidak ada korelasi antara jenis statin dengan kadar gula darah puasa.

Simpulan: Durasi terapi statin memiliki hubungan lemah dengan kadar gula darah puasa sehingga terapi statin masih dapat diberikan dengan memperhatikan keuntungan terapi yang lebih besar. Pencegahan terhadap risiko diabetes onset baru tetap dilakukan dengan modifikasi gaya hidup serta pemantauan gula darah berkala.

Kesesuaian hasil pengukuran Low Density Lipoprotein Cholesterol menggunakan persamaan Friedewald, Hopkins, dan Homogeneous Enzymatic Colorimetric Assay di RSUP Sanglah, Bali, Indonesia

Background: LDL-C concentration can be obtained by calculation from equations and measurement methods. There are many LDL-C equations, but the most commonly used is the Friedewald equation, and the most recent is the Hopkins equation. This study aims to determine LDL-C measurements' agreement using the Friedewald equation, Hopkins equation, and homogeneous enzymatic colorimetric assay.

Methods: This was a cross-sectional study, from January-February 2020, with 570 samples LDL-C examination results by Friedewald equation, Hopkins equation, and homogeneous enzymatic colorimetric assay divided into 3 groups based on TG levels. Data were analyzed by SPSS version 17 for Windows.

Results: Spearman correlation test found a near-perfect correlation between LDL-C using Friedewald and Hopkins equations to direct examinations with values r =0.921 and r =0.907. Limit of agreement from the Bland-Altman test shows an average of >90% for both equations with direct measurements. Mann-Whitney test showed a significant difference between LDL-C direct measurement and Friedewald equation in Total Group, TG 200-400 mg/dL and TG> 400 mg/dL while for Hopkins equation only in TG group> 400 mg/dL (p<0.05). Based on Total Allowable Error (TAE) analysis, LDL-C from Hopkins equation in TG group 200-400 mg/dL appears to be superior to the Friedewald equation.

Conclusion: Friedewald equation and Hopkins equation give good concordance at TG levels <200 mg/dL while at triglyceride levels 200-400 mg/dL Hopkins equation gives better concordance than the Friedewald equation. At triglyceride levels,> 400 mg/dL Friedewald and Hopkins equations show low accuracy, so it is recommended to use the direct method.

Latar Belakang: Konsentrasi low density lipoprotein cholesterol (LDL-C) dapat diperoleh dengan 2 cara yaitu menggunakan perhitungan dengan persamaan dan metode pengukuran langsung (direct). Banyak persamaan perhitungan LDL-C tetapi yang paling umum digunakan adalah persamaan Friedewald dan yang terbaru adalah persamaan Hopkins. Penelitian ini bertujuan untuk mengetahui kesesuaian hasil pengukuran LDL-C menggunakan persamaan Friedewald, persamaan Hopkins dan homogeneous enzymatic colorimetric assay

Metode: Penelitian menggunakan rancangan analitik potong lintang dari bulan Januari-Pebruari 2020 dengan 570 sampel hasil pemeriksaan LDL-C dengan persamaan Friedewald, persamaan Hopkins dan homogeneous enzymatic colorimetric assay yang dibagi 3 kelompok berdasarkan kadar trigliserida (TG). Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Uji statistik Spearman didapatkan korelasi mendekati sempurna antara  LDL-C menggunakan persamaan Friedewald dan Hopkins terhadap pemeriksaan direct dengan nilai r=0,921 dan r=0,907. Limit of agreement dari uji Bland-Altman menunjukkan rata-rata > 90% untuk kedua persamaan dengan pengukuran direct. Uji Mann-Whitney menunjukkan perbedaan bermakna antara LDL-C pengukuran direct dengan persamaan Friedewald pada Kelompok Total, TG 200-400 mg/dL dan TG >400 mg/dL sedangkan untuk persamaan Hopkins perbedaan hasil yang bermakna hanya pada kelompok TG >400 mg/dL (p<0,05). Berdasarkan analisis Total Allowable Error (TAE), LDL-C persamaan Hopkins pada kelompok TG 200-400 mg/dL lebih unggul dari persamaan Friedewald.

Kesimpulan: Persamaan Friedewald dan persamaan Hopkins memberikan kesesuaian yang baik pada kadar TG <200 mg/dL sedangkan pada kadar trigliserida 200-400 mg/dL, persamaan Hopkins memberikan kesesuaian yang lebih baik daripada persamaan Friedewald. Pada kadar TG >400mg/dL persamaan Friedewald dan Hopkins menunjukkan akurasi yang rendah sehingga disarankan untuk menggunakan metode direct.

Hubungan diabetes mellitus dengan obstructive sleep apnea (OSA) di Gedung Mario Tabanan, Bali-Indonesia

Background: Diabetes mellitus (DM) is a chronic case caused by the pancreas not being able to produce insulin and when there is insulin resistance. This disease is characterized by a lot of drinking, eating, weight loss and frequent urination. This drastic weight loss results in a decrease in body mass, one of which is the nasopharynx and oropharynx so that it can cause collapse and cause Obstructive sleep apnea (OSA). This study aims to determine whether there is a relationship between diabetes mellitus and OSA in the social service held at the Mario Tabanan building on June 16, 2008.

Methods: An observational analytic study with cross sectional design with a sample of 110 people. This study was conducted at Mario Building, Tabanan, Bali, Indonesia.

Results: A total of 110 samples were successfully collected in this study, with an age range of 50-70 years, 55 patients with diabetes mellitus (DM) and 55 patients without diabetes. From the research above, it was found that there were more men than women, namely 67 people (58.3%) and women amounting to 43 people (42.7%). The average age who received OSA was 57.35 ± 10.89. The results of the study of the prevalence of patient respondents who suffered from DM with OSA were 65 people (53.5%) and patients who did not suffer from DM were 45 (46.5) and patients who did not have DM with OSA were 46 people (47.8%), and those who did not have diabetes and no OSA were 64 people (52.2%). There was a significant relationship between OSA and DM with a p value <0.05 and the prevalence ratio value was the Prevalent Ratio (RP) 1.432 with a confidence interval (1.024 to 5.980).

Conclusion: Diabetes is a risk factor for OSA, and there is a significant relationship between diabetes and the incidence of OSA.

Latar Belakang: Diabetes mellitus (DM) merupakan kasus kronis yang diakibatkan pankreas tidak mampu memproduksi insulin dan ketika ada resistensi insulin. Penyakit ini ditandai dengan banyak minum, makan, berat badan turun drastis dan sering buang air kecil. Penurunan berat badan drastis ini mengakibatkan penurunan massa otot tubuh salah satunya adalah nasofaring dan orofaring sehingga dapat menyebabkan kolaps dan menimbulkan terjadinya Obstructive sleep apnea (OSA). Penelitian ini bertujuan mengetahui apakah ada hubungan antara diabetes mellitus dan OSA pada baksos yang diadakan di gedung Mario Tabanan pada tanggal 16 Juni 2008.

Metode: Penelitian analitik observasional dengan rancangan cross sectional dengan sampel sebanyak 110 orang yang dilakukan di Gedung Mario Tabanan, Bali, Indonesia.

Hasil: Total 110 sampel berhasil dikumpulkan dalam penelitian ini, dengan rentangan usia 50-70 tahun, 55 pasien dengan diabetes mellitus (DM) dan 55 pasien tidak DM. Dari penelitian diatas didapatkan laki-laki lebih banyak daripada perempuan yaitu 67 orang (58,3%) dan perempuan berjumlah 43 orang (42,7%). Rata rata umur yang mendapatkan  OSA 57,35± 10,89. Hasil penelitian prevalensi responden pasien yang menderita DM dengan OSA adalah 65 orang (53,5%) dan, pasien yang tidak menderita DM adalah sejumlah 45 (46,5) dan pasien yang tidak DM dengan OSA adalah sejumlah 46 orang (47,8%) dan yang tidak DM dan tidak OSA adalah 64 orang (52,2%) Didapatkan adanya hubungan signifikan antara OSA dengan DM dengan nilai p<0,05 dan nilai rasio prevalens adalah Rasio Prevalen (RP) 1,432 dengan interval kepercayaan (1,024 sampai 5,980).

Simpulan: Diabetes merupakan faktor risiko dari terjadinya OSA, dan didapatkan hubungan yang bermakna antara diabetes terhadap kejadian OSA.

Brittle bone brothers: osteogenesis imperfecta conventional serial case

Background: Osteogenesis Imperfecta (OI) is a heredity connective tissue disorder due to COL1A1/2 gene mutation, causing a defect in encoding proteins to metabolize collagen. One of OI’s manifestations to musculoskeletal is bone incompetence, hence the name Brittle bone disease. We report three cases of OI type IV in adults with pathognomonic radiology findings.

Case Presentation: In Case 1, a 40-year-old Indonesian male came to the hospital with small stature and unsuited with his age. Conventional radiology examination found OI on all four extremities, anterior dislocation of left shoulder, and old fracture with an acute angle in the left radial shaft. In Case 2, a 41-year-old Indonesian male came to the hospital with short stature, causing limitation to his activities, and he confessed always to be shorter than people his age. Radiology evaluation suggests an OI in bilateral superior and inferior extremities, old fractures in the right humeral shaft also the left clavicle, acute angles right radius-ulna shaft, and osteoporosis in all visualized bones. In addition, in Case 3, a 42-year-old Indonesian male came to the hospital with short stature and pain within his bones, causing limitation to his activity. Conventional radiology imaging shows bilateral superior and inferior extremities, old fracture in the medial third of the left humerus and bilateral femur, acute-angled bilateral antebrachial-femur-cruris, and osteoporosis

Conclusion: Based on OI categorization, only type I and IV can live to adulthood, and the same type of OI can be found in siblings. Conventional radiology imaging provides a great help in diagnosing OI.

Prevalensi kejadian perdarahan uterus abnormal di Rumah Sakit Umum Daerah Wangaya Denpasar periode Januari – Desember 2020

Introduction: Abnormal uterine bleeding (AUB) is the most common gynecological disorder experienced by women of reproductive age. The Federation of Gynecology and Obstetrics (FIGO) classifies AUB according to its etiology into PALM-COEIN. This study aims to determine the prevalence of AUB incidence according to the FIGO classification and AUB patients' characteristics based on age group, parity, BMI, and educational level at Wangaya Hospital Denpasar.

Method: The study design is descriptive retrospective. Samples were collected by total sampling. Data was taken from medical records of patients diagnosed with AUB in Obstetrics-Gynaecology Polyclinic and Obstetrics-Neonatal Comprehensive Emergency Services at Wangaya Hospital Denpasar period January-December 2020.

Result: The results showed 68 cases of AUB (15.8%) from 437 gynecologic cases. AUB due to structural abnormalities is 45 people (66.2%) with the most cases being AUB-L are 26 people (38.2%). In comparison, AUB was not due to structural abnormalities are 23 people (33.8%) with the most cases AUB-O, namely 18 people (26.4%). The AUB incidence most occurred in the age group ?41 years which is 25 people (36.8%). Parity ?2 times had the most AUB incidence, namely 26 people (57.8%). The most AUB incidence in normal BMI (18.5-24.9), namely 53 people (77.8%), and 37 people (54.4%) at the nongraduated.

Conclusion: Prevalence of AUB incidents at Wangaya Hospital Denpasar period January-December 2020 almost one-fifth of all gynecological cases. The AUB incidence most prevalent in the age group ?41 years, parity ? 2 times, normal BMI, and non-graduated.

Latar Belakang: Perdarahan uterus abnormal (PUA) merupakan kelainan di bidang ginekologi yang paling sering dialami oleh perempuan usia produktif. Federation of Gynecology and Obstetrics (FIGO) mengklasifikasikan PUA menurut etiologinya menjadi PALM-COEIN. Penelitian ini bertujuan untuk mengetahui prevalensi kejadian PUA sesuai klasifikasi FIGO dan mengetahui karakteristik pasien PUA berdasarkan kelompok usia, paritas, IMT, dan tingkat pendidikan di RSUD Wangaya Denpasar.

Metode: Rancangan penelitian yang digunakan adalah deskriptif retrospektif. Teknik penentuan sampel yang digunakan adalah total sampling. Data penelitian didapatkan dari rekam medis pasien di Poliklinik Kebidanan-Kandungan dan Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK) Rumah Sakit Umum Daerah (RSUD) Wangaya Denpasar periode Januari – Desember 2020.

Hasil: Dari hasil penelitian didapatkan 68 kasus PUA (15,8%) dari 437 kasus di ginekologi. PUA karena kelainan struktural sebanyak 45 orang (66,2%) dengan kasus terbanyak adalah PUA-L 26 orang (38,2%), sedangkan PUA bukan karena kelainan struktural sebanyak 23 orang (33.8%) dengan kasus terbanyak PUA-O yaitu 18 orang (26,4%). Kejadian PUA paling banyak terjadi pada kelompok usia ?41 tahun sebanyak 25 orang (36,8%). Paritas ?2 kali paling banyak mengalami kejadian PUA yaitu 26 orang (57,8%). Kejadian PUA paling banyak pada IMT Normal (18,5-24,9) yaitu 53 orang (77,8%), dan tingkat pendidikan bukan Sarjana/D3 sebanyak 37 orang (54,4%).

Simpulan: Prevalensi Kejadian PUA di RSUD Wangaya Denpasar periode Januari – Desember 2020 hampir seperlima dari seluruh kasus ginekologi. Kejadian PUA paling banyak terjadi pada kelompok usia ?41 tahun, paritas ?2 kali, IMT normal, dan tingkat pendidikan bukan Sarjana/D3.

Tatalaksana bedah pada eksotropia traumatika et causa ruptur total otot rectus medial: laporan kasus

Introduction: Traumatic strabismus may result because of closed or open head and/or orbital trauma. Trauma to the extraocular muscles will often result directly in specific ocular motility disorders. Vertical transposition is one of the surgical management in traumatic exotropia with medial rectus muscle total rupture. The aims of case report are to know about examination and management in patient with traumatic exotropia.

Case Illustration: Male, 30 years old, came with chief complaints pain on the right eye after being exposed a wire bounce when take off a banner wire, with squint eye, blurry vision, diplopia, redness, bleeding. On ophthalmology examination, 45° exotropia, visual acuity on the right eye 6/18 ph NI, proptosis, edema, hematom, spasm palpebral. Medial rectus muscle rupture, full thickness conjunctival rupture, cresent shaped, 15x7mm, 3 mm from limbal. Eyeball movement limited to medial, superomedial, inferomedial, FGT medial parese right eye (RE). visual acuity on the left eye 6/6, anterior and posterior segment within normal limit. Patient was diagnosed with traumatica exotropia et causa medial rectus muscle total rupture right eye (RE) with complication axial proptosis ec retrobulbar hemorrhage, palpebral hematom, full thickness conjunctival ruptured, sub conjunctival bleeding, erosion cornea, iridoplegy, traumatic iritis. Vertical transposition with augmented Hummelsheim technique, cantotomy cantolysis, repair conjunctival ruptured was done to the patient.

Conclusion: Vertical transposition is one of the surgical management in traumatic exotropia caused by medial rectus muscle total rupture 

Pendahuluan: Eksotropia traumatik dapat disebabkan oleh adanya trauma terbuka/tertutup pada kepala/mata. Trauma pada otot ekstraokuler akan menyebabkan gangguan gerakan bola mata yang spesifik. Salah satu penanganan bedah pada eksotropia traumatik karena ruptur total otot rektus medial adalah dengan transposisi vertikal. Tujuan dari pembuatan laporan kasus in adalah untuk mengetahui pemeriksaan dan penanganan pasien dengan eksotropia traumatika.

Laporan kasus: Pria dengan usia 30 tahun, datang dengan keluhan nyeri pada mata kanan setelah terkena pentalan kawat, disertai mata juling keluar, pandangan ganda, kabur, berdarah, mata merah. Pada pemeriksaan oftalmologi didapatkan eksotropia 45°, tajam penglihatan mata kanan 6/18 ph NI, dengan proptosis, edema, hematom, spasme pada palpebra. Pada konjungtiva didapatkan tampak ruptur rektus medialis, ruptur konjungtiva full thickness bentuk bulan sabit ukuran 15x7mm, 3 mm dari limbus. Gerakan bola mata terhambat ke medial, superomedial, inferomedial, Forced Generation Test (FGT) mata kanan paresis ke medial. Tajam  penglihatan mata kiri 6/6, segmen anterior dan posterior dalam batas normal. Pasien didiagnosis dengan eksotropia traumatika et causa ruptur total otot rektus medial oculi dextra (OD) dengan komplikasi proptosis axial ec suspek pendarahan retrobulbar, hematom palpebral, ruptur konjungtiva full thickness, pendarahan sub konjungtiva, erosi kornea, iridoplegia, traumatic iritis. Pada pasien ini dilakukan transposisi vertikal dengan teknik augmented Hummelsheim, kantotomi kantolisis, dan repair ruptur konjungtiva full thickness.

Simpulan: Transposisi otot rektus vertikal merupakan salah satu tindakan untuk tatalaksana pembedahan pada eksotropia traumatika et causa ruptur total otot rektus medial

Prevalensi obesitas pada pasien kanker kolorektal di RSUP Sanglah periode 2019 - 2020

Background: Colorectal cancer is cancer that develops slowly and begins as a tumor or growth of tissue from the inner surface of the rectum or colon. Colorectal cancer can be influenced by exogenous factors that can be modified, one of which is obesity. This study aims to determine the prevalence of obesity in colorectal cancer patients.

Methods: This research was a descriptive study with a retrospective approach using medical record data and the sampling technique was total sampling. The data obtained according to the inclusion and exclusion criteria were 100 data which were then analyzed using SPSS version 20 for Windows. Data was taken from the 100 medical records for age, sex, Body Mass Index (BMI), and histopathology of colorectal cancer. The data was obtained from the Installation Medical Record at Sanglah Hospital.

Results: The results found a difference in colorectal cancer patients with BMI ?25 and <25 kg/m². Patients with a BMI <25 kg/m² were 90 patients (90.00%) more suffering from colorectal cancer than 10 patients (10.00%) who had a BMI ?25 kg/m². Based on age, the most colorectal cancer was found at ? 56 years old, namely 52.0%. In contrast, based on the type of cancer, there were more adenocarcinoma types, namely 88 patients (88.0%) compared to histopathological types of cancer that were difficult to find (12.00%).

Conclusion: From the results of this study, it can be concluded that colorectal cancer patients attack more than or equal to 56 and BMI <25 kg/m².

Latar Belakang: Kanker kolorektal merupakan kanker yang berkembang dengan lambat dan berawal sebagai tumor atau perkembangan jaringan dari permukaan dalam rektum atau kolon. Kanker kolorektal dapat dipengaruhi oleh faktor eksogen yang dapat dimodifikasi salah satunya adalah obesitas. Penelitian ini bertujuan untuk mengetahui prevalensi obesitas pada pasien kanker kolorektal.

Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan retrospektif menggunakan data rekam medis dan teknik pengambilan sampel adalah total sampling. Data yang diperoleh sesuai dengan kriteria inklusi dan eksklusi sebanyak 100 data yang kemudian dianalisis menggunakan SPSS versi 20 untuk Windows. Dari 100 rekam medis diambil data umur, jenis kelamin, IMT dan histopatologi kanker kolorektal. Data diperoleh dari Instalasi Rekam Medis RSUP Sanglah.

Hasil: Pada hasil ditemukan adanya perbedaan pada pasien kanker kolorektal dengan IMT?25 dengan <25 kg/m². Pasien dengan IMT<25 kg/m² yaitu sebanyak 90 pasien (90,0%) lebih banyak menderita kanker kolorektal dibandingkan dengan 10 pasien (10,0%) yang memiliki IMT ?25 kg/m². Dilihat dari usia pasien, didapatkan kanker kolorektal paling banyak pada usia ? 56 tahun yaitu 52,0%, sedangkan pada jenis kanker didapatkan tipe adenokarsinoma lebih banyak yaitu 88 pasien (88,0%) dibandingkan tipe histopatologi kanker yang sulit dijelaskan (12,0%).

Kesimpulan: Dari hasil penelitian ini dapat disimpulkan bahwa pasien kanker kolorektal lebih banyak menyerang pada usia lebih dari atau sama dengan 56 dan IMT <25 kg/m².

Gonadotropin Releasing Hormone Agonis (GNRH-A) vs Human Chorionic Gonadotropin (hCG) vs Gonadotropin Releasing Hormone Agonis (GNRH-A) + Human Chorionic Gonadotropin (HCG) sebagai stimulan pematangan oosit, tingkat pembuahan, kualitas embrio, tingkat keha

Background: The stimulation of Human Chorionic Gonadotropin (hCG) vs. Gonadotropin-Releasing Hormone (GnRH) agonists vs. hCG + GnRH agonists plays an important role in influencing oocyte maturation, fertilization, embryo quality, pregnancy, live birth rates, and Ovarian Hyperstimulation Syndrome (OHSS) during IVF. This study aims to determine the effectiveness of hCG vs. GnRH agonist stimulation vs. hCG + GnRH agonists regarding oocyte maturation levels, embryo quality, fertilization, pregnancy, live birth rates, and OHSS while undergoing IVF program.

Methods: This cross-sectional analytic study was conducted on 86 samples, including 33 hCG group, 12 GnRH agonist group, and 41 hCG + GnRH agonist group. The secondary data was obtained from the IVF clinical laboratory results at Puri Bunda Hospital and BROS hospital. Data were analyzed using SPSS version 20 for Windows.

Results: There were no significant differences in age, duration of infertility, levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol, duration of stimulation, level of oocyte maturation, fertilization, embryo quality, pregnancy, live birth rate and OHSS ( p> 0.05) in each group. However, there was a significant difference in the Body Mass Index (BMI) (p = 0.032) and the number of oocytes (p = 0.020) in each group.

Conclusion: There were no significant differences in oocyte maturation, fertilization rates, embryo quality, pregnancy, live birth rates, and OHSS. 

Latar Belakang: Stimulasi Human Chorionic Gonadotropin (hCG) vs Gonadotropin Releasing Hormone (GnRH) agonis vs hCG+GnRH agonis berperan penting dalam mempengaruhi pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup, dan Ovarian Hiperstimulation Syndrome (OHSS) pada saat menjalani program bayi tabung. Penelitian ini bertujuan untuk mengetahui efektifitas dari stimulasi hCG vs GnRH agonis vs hCG+GnRH agonis mengenai tingkat pematangan oosit, kualitas embrio, pembuahan, kehamilan, kelahiran dan OHSS saat menjalani program bayi tabung.

Metode: Penelitian potong lintang analitik ini dilakukan terhadap 86 sampel meliputi 33 kelompok hCG, 12 kelompok GnRH agonis, dan 41 kelompok hCG+GnRH agonis. Data sekunder diperoleh dari hasil laboratorium klinik IVF Rumah Sakit Puri Bunda dan rumah sakit BROS. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Tidak terdapat perbedaan bermakna pada usia, durasi infertilitas, kadar Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol, durasi stimulasi, tingkat pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup dan OHSS (p>0,05) pada masing-masing kelompok. Namun, terdapat perbedaan bermakna pada Indeks Massa Tubuh (IMT) (p=0,032) dan jumlah oosit (p=0,020) pada masing-masing kelompok.

Kesimpulan: Tidak ditemukannya perbedaan yang bermakna pada tingkat pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup dan OHSS.

Hubungan antara ekspresi Vascular Endothelial Growth Factor (VEGF) dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar, Bali

Background: Osteosarcoma is the most common malignant primary bone tumor. Although osteosarcoma cases are relatively rare compare to carcinoma, the mortality rate is quite high. Osteosarcoma prognosis can be seen from conventional pathology and biological markers, such as Vascular Endothelial Growth Factor (VEGF). In various studies, the presence of VEGF expression has been associated with the worsening prognosis of osteosarcoma. This study aims to determine the relationship between VEGF expression and osteosarcoma's clinicopathological characteristics at Sanglah General Hospital, Denpasar, 2015-2019.

Method: This research is a cross-sectional analytic study. The sampling technique used all affordable populations that were included in the inclusion criteria, with a total sample of 30 samples. The research data used secondary data obtained from the archive of histopathological examination reports at the Anatomical Pathology Laboratory at Sanglah General Hospital and paraffin blocks from all available samples for immunohistochemical examination. Data were analyzed using SPSS version 22 for Windows.

Results: The clinicopathological characteristics of the osteosarcoma studied were age, tumor location, histological type, and grading. Patients with osteosarcoma in this study were predominantly found in the age group <20 years (66.67%), femur locations (60.00%), mixed type osteosarcoma (53.33%), and high grade (100.00%). A total of 26 samples (86.67%) had high VEGF expression and 4 samples had low VEGF expression (13.30%). There was no significant relationship between age (p=0.241), location of the tumor (p=0.739), and histological type (p=1.000) to the VEGF expression.

Conclusion: The relation between each osteosarcoma clinicopathological characteristic associated with VEGF expression showed insignificant results in age, location, and histological type. Further research is needed with a more significant number of samples to get better results.

Latar Belakang: Osteosarkoma adalah tumor tulang primer ganas yang paling umum. Meskipun kasus osteosarkoma relatif jarang dibandingkan dengan karsinoma, angka kematiannya cukup tinggi. Prognosis osteosarkoma dapat dilihat dari patologi konvensional dan penanda biologis, salah satunya adalah Vascular Endothelial Growth Factor (VEGF). Dalam berbagai penelitian, kehadiran ekspresi VEGF telah dikaitkan dengan prognosis yang memburuk dari osteosarcoma. Penelitian ini bertujuan untuk mengetahui hubungan ekspresi VEGF dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar tahun 2015-2019.

Metode: Penelitian ini merupakan penelitian analitik potong lintang. Teknik pengambilan sampel menggunakan semua populasi terjangkau yang termasuk dalam kriteria inklusi, dengan jumlah sampel sebanyak 30 sampel. Data penelitian menggunakan data sekunder yang diperoleh dari arsip laporan pemeriksaan histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah dan blok parafin dari semua sampel yang tersedia untuk pemeriksaan imunohistokimia. Data dianalisis dengan SPSS versi 22 untuk Windows.

Hasil: Karakteristik klinikopatologi dari osteosarkoma yang diteliti adalah usia, lokasi tumor, tipe histologis, dan grading. Penderita osteosarkoma pada penelitian ini paling banyak ditemukan pada kelompok usia <20 tahun (66,67%), lokasi femur (60%), tipe campuran osteosarkoma (53,33%) dan High-Grade (100.00%). Sebanyak 26 sampel (86,67%) memiliki ekspresi VEGF tinggi dan 4 sampel memiliki ekspresi VEGF rendah (13,30%). Tidak terdapat hubungan yang bermakna antara usia (p=0,241), lokasi (p=0,739), dan tipe histologis (p=1,000).

Kesimpulan: Hubungan antara masing-masing karakteristik klinikopatologi osteosarkoma yang terkait dengan ekspresi VEGF menunjukkan hasil yang tidak bermakna pada usia, lokasi, dan tipe histologis. Diperlukan penelitian lebih lanjut dengan jumlah sampel yang lebih banyak untuk mendapatkan hasil yang lebih baik.

Correlation of glutamine and serial absolute neutrophil count as a parameter of infection in major burn trauma patients at Sanglah General Hospital, Bali, Indonesia

Background: Burns are thermal trauma that often results in high morbidity. In major burns, gastrointestinal dysfunction plays a vital role in the progression of infection to organ failure. Glutamine is a pharmaconutrient that has important implications for burn patients, including in the prevention of infection. This study evaluates the relationship between glutamine administration and the serial absolute neutrophil count as a parameter for infection incidence in patients with major burns.

Methods: This study was an analytical study with a cross-sectional design to see the relationship between glutamine administration and the serial absolute neutrophil count levels of major burn patients at Sanglah General Hospital. The sample consisted of 56 patients from the medical records of burn patients. The data were extracted from the medical records and then inserted into the data collection sheet. Then performed data analysis using SPSS version 21 for Windows.

Results: Bivariate analysis showed that there was a significant difference between glutamine administration and the absolute neutrophil count levels on days 3, 5, and 14 (p = 0.004, 95% CI: 1.70-8.46), (p = 0.000, 95% CI: 2.71-7.83), and (p = 0.035, 95% CI: 0.61-7.27), respectively. This showed that patients given glutamine had lower neutrophil levels on days 3, 5, and 14 than patients who were not given glutamine. Multivariate analysis confirmed that glutamine administration did independently affect and decrease the absolute neutrophil count levels on days 3, 5, 14, and the mean without being influenced by other variables with p value = 0.004 (95% CI: [-8.445] - [-1,732]), p = 0.000 (95% CI: [-7,808]-[-2,743]), p = 0.020 (95% CI: [-7.251]-[-0.639]), and p = 0.017 (95% CI: [-5,815]-[-0.588]), respectively.

Conclusion: This study has shown that glutamine administration was significantly associated with and decreased the serial absolute neutrophil count in major burn patients.

Faktor-faktor klinikopatologi kekambuhan kanker serviks stadium I-IIA2 pasca histerektomi radikal di RSUP Sanglah periode 2019–2020

Background: Cervical cancer is the second-largest malignant disease in Indonesia. Recurrence in early-stage cervical cancer is high. However, data of clinicopathological factors for recurrence of early stage cervical cancer in Indonesia, especially in Denpasar, are still challenging to find. Thus, this study aims to determine the clinicopathological factors for recurrence cervical stage I-IIA2 post radical hysterectomy at Sanglah General Hospital.

Methods: This research is an analytical cross sectional study using medical record data and the sampling technique is total sampling. According to the inclusion and exclusion criteria, the data obtained were 46 data, which were then analyzed using SPSS version 25 for Windows.

Results: The bivariate analysis of this study showed that the variables age, histopathology, incision margin, and parametrial involvement were not significantly associated with the recurrence rate (p> 0.05). The factors significantly associated with the recurrence rate were a clinical stage, tumor size, and positive lymph nodes (p <0.05).

Conclusion: Clinical stage, tumor size, and lymph node metastases are three independent factors for cervical cancer recurrence after radical hysterectomy surgery.

Keywords: Cervical Cancer, Recurrence, Radical Hysterectomy, Sanglah General Hospital Denpasar.

Latar belakang:  Kanker serviks adalah penyakit keganasan kedua terbanyak di Indonesia. Kekambuhan pada kanker serviks stadium awal tergolong tinggi. Namun, data mengenai faktor-faktor kekambuhan kanker serviks stadium awal di Indonesia khususnya di Denpasar masih sulit ditemukan. Sehingga, penelitian ini bertujuan untuk mengetahui faktor-faktor kekambuhan kanker serviks stadium I-IIA2 pasca histerektomi radikal di RSUP Sanglah Denpasar.

Metode: penelitian ini merupakan penelitian analitik potong lintang dengan menggunakan data rekam medis dan teknik penentuan sampel adalah Total Sampling.  Data yang didapat sesuai kriteria inklusi dan eksklusi adalah 46 data yang kemudian doiolah dengan SPSS versi 25 untuk Windows.

Hasil: Analisis bivariat penelitian ini menunjukan bahwa variabel usia, histopatologi, batas sayatan, dan keterlibatan parametrium tidak berhubungan secara bermakna dengan tingkat kekambuhan (p>0,05). Faktor-faktor yang berhubungan secara bermakna dengan tingkat kekambuhan adalah stadium klinis, ukuran tumor, dan kelenjar limfe positif (p<0,05).

Kesimpulan: Stadium klinis, ukuran tumor, dan metastasis pada kelenjar limfe adalah tiga faktor independen untuk kekambuhan kanker serviks setelah operasi radikal histerektomi.

The use of compression stockings produces lower Interleukin-6 (IL-6) levels, Higher American Orthopaedic Foot and Ankle Society Score (AOFAS), and does not produce higher alkaline phosphatase level in postoperative patients with fracture around the ankle

Background: Fractures around the ankles are common injuries. The use of compression stockings is one of the postoperative modalities that has been widely used in developing countries but is rarely used in Indonesia. This study aimed to determine the effect of using compression stockings on changes in inflammatory biomarkers level and functional outcomes in postoperative patients with fractures around the ankle.

Methods: This study was a randomized clinical trial (post-operative-only design) in 26 patients with fractures around the ankle. The study subjects were divided into groups using postoperative compression stockings and groups without compression stockings. Its efficacy was assessed by measuring levels of Interleukin-6 (IL-6), Alkaline Phosphatase (ALP), and American Orthopedic Foot and Ankle Society (AOFAS) scores. Data were analyzed using SPSS version 20 for Windows.

Results: Postoperative 24-hour IL-6 levels were not significantly different (p=0.200; -59.93–266.42), but they were significantly different postoperatively in 3 days (p = 0.001; 8.76-30.21), 14 days (p=0.015; 2.40-20.49), and 30 days (p=0.000; -15.49–[-5.03]). ALP was not different significantly, both at 24 hours (p=0.160; -16.0-2.80), 3 days (p=0.072; -0.65-14.19), 14 days (p=0.098; -1,310–12,54), and 30 days (p=0.419; -5.00–11.61) after surgery. The AOFAS scores was different significantly 30 days postoperatively (p=0.000; -3.915– [-1.469]).

Conclusion: The use of compression stockings can be considered as postoperative therapy to lower the IL-6 levels but do not affect ALP levels in postoperative patients with fractures around the ankle. The use of compression stocking resulted in a higher AOFAS score than without wearing compression stockings in postoperative patients with fractures around the ankle.

Epidemiologi pasien luka bakar di RSUP Sanglah Denpasar tahun 2018-2019

Background: Burns are loss of tissue or a form of tissue damage that occurs as a result of contact with heat sources such as fire, chemicals, hot water, electricity, and radiation which are a type of trauma with high morbidity and mortality so that they require special treatment from the initial phase to advanced phase. This study aims to find out, comprehend, and describe the epidemiology of burn patients' causes and mortality at the Sanglah General Hospital in 2018-2019.

Methods: The research was conducted with a descriptive method using cross-sectional studies. Samples were selected from the population-based on inclusion and exclusion criteria. Data were analyzed using SPSS version 24 software to obtain the epidemiology of the causes, length of stay, and burns mortality.

Results: The results showed that the highest cause of burns was caused by fire, namely 65 people (53.3%). In the adult group, most burns were caused by fire, namely 55 people (45.1%), while in the group of children, most burns were caused by objects / hot water, namely 14 people (11.5%). The mortality of burnt sufferers was 11 people (9%) out of 122 people (100%), where all deaths occurred in the adult group. An IIAB degree burns were the highest burns with the highest mortality with 10 people (90.9%). Most of the burn injuries caused by fire burns were 7 people (63.6%) and the highest case was second-degree burns caused by fire, namely 60 people (56.1%).

Conclusion: The results showed that the most common burns were caused by a fire in the adult group and objects/hot water in the children group. IIAB degree burns are the highest degree of burns with mortality.

Latar Belakang: Luka bakar adalah kehilangan jaringan atau suatu bentuk kerusakan jaringan yang terjadi akibat dari kontak dengan sumber panas seperti api, bahan kimia, air panas, listrik dan radiasi yang merupakan jenis trauma dengan morbiditas dan mortalitas yang tinggi sehingga memerlukan perawatan yang khusus mulai fase awal hingga fase lanjut. Penelitian ini bertujuan untuk mengetahui, memahami dan mendeskripsikan epidemiologi penyebab dan mortalitas pasien luka bakar di Rumah Sakit Umum Pusat Sanglah Denpasar tahun 2018-2019.

Metode: Penelitian dilakukan dengan metode deskriptif menggunakan studi potong lintang. Sampel dipilih dari populasi berdasarkan kriteria inklusi dan eksklusi. Data dianalisis menggunakan software SPSS versi 24 untuk mendapatkan epidemiologi penyebab dan mortalitas luka bakar.

Hasil: Hasil penelitian menunjukkan bahwa epidemiologi penyebab luka bakar tertinggi disebabkan oleh api yaitu 65 orang (53,3%).  Pada kelompok dewasa, pasien luka bakar terbanyak disebabkan oleh api yaitu 55 orang (45,1%), sedangkan pada kelompok anak-anak luka bakar terbanyak disebabkan oleh benda/air panas yaitu 14 orang (11,5%). Mortalitas pasien luka bakar yaitu 11 orang (9%) dari 122 orang (100%), dimana semua kematian terjadi pada kelompok dewasa. Luka bakar derajat IIAB merupakan derajat luka bakar dengan kematian tertinggi yaitu 10 orang (90,9%). Kematian luka bakar terbanyak disebabkan oleh luka bakar akibat api sebanya 7 orang (63,6%) dan kasus tertinggi adalah luka bakar derajat IIAB yang disebabkan oleh api yaitu 60 orang (56,1 %).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa luka bakar tersering disebabkan oleh api pada kelompok dewasa dan benda/air panas pada kelompok anak-anak. Luka bakar derajat IIAB merupakan derajat luka bakar dengan kematian tertinggi.

Hubungan andropause dengan skor IPSS pada pegawai di institusi pusat pemerintahan Kabupaten Badung-Bali

Background: Andropause is a term which indicate reduced male testosterone levels. The mechanism of andropause is due to decreased male reproductive function which results in decreased levels of testosterone in the blood below normal levels. On the other hand, almost 50% of men aged 45-60 years experience complaints of urination due to Benign Prostate Hyperplasia (BPH). Until now, BPH is believed to be related to the aging process and decreased levels of the hormone testosterone or andropause. However, no clear evidence indicate a relathionship between andropause and severe micturition probelm. This study aims to determine the relathionship of andropause and the IPSS score.

Methods: This study is an analytic observational study with a cross sectional method. Sampling in this study using purposive sampling with respondent taken from the Central Government Institution of Badung Regency, Bali. The total number of research respondents was 40 man. Symptoms and signs of andropause were evaluated using the Androgen Deficiency in the Aging Male (ADAM) questionnaire, while the degree of symptoms of micturition was determined by the International Prostate Symptom Score (IPSS). The data was analyze descriptively and analytically with Chi-square to determine the relationship between andropause status and the degree of micturition problem.

Results: Complaints of moderate micturition problem were the most common complaint in andropause respondents (45.5%) while mild complaints were the most common among respondents who did not experience andropause (72.2%). The results showed a significant relationship between respondents who experienced andropause and the tendency to complain of symptoms of obstruction due to prostate enlargement as assessed by the IPSS score (p = 0.038).

Conclusion: There is a significant relationship between respondents experiencing andropause and the tendency to complain of symptoms of obstruction due to prostate enlargement.

Pendahuluan: Andropause merupakan suatu istilah yang berarti menurunnya kadar hormon testosteron pada laki-laki. Mekanisme terjadinya andropause adalah karena menurunnya fungsi reproduksi laki-laki yang berakibat menurunnya kadar testosteron dalam darah dibawah angka normal. Disisi lain, laki-laki usia 45-60 tahun hampir 50% mengalami keluhan miksi akibat Benign Prostate Hyperplasia (BPH). BPH hingga saat ini diyakini berhubungan dengan proses penuaan dan penuruan kadar hormon testosteron atau andropause. Akan tetapi belum banyak bukti menunjukan hubungan andropause dengan beratnya gangguan miksi akibat BPH. Penelitian ini bertujuan untuk mengetahui hubungan status andropause dengan skor IPSS.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan metode potong lintang. Pengambilan sampel pada penelitian ini menggunakan purposive sampling dengan responden diambil dari Institusi Pusat Pemerintah Kabupaten Badung, Bali. Keseluruhan responden penelitian berjumlah 40 orang. Gejala dan tanda andropause dievaluasi dengan kuisioner Androgen Deficiency in the Aging Male (ADAM) sedangkan derajat gejala gangguan miksi ditetukan dengan skor International Prostate Symptom Score (IPSS). Analisis data berupa deskriptif serta analitik dengan Chi-square untuk menentukan hubungan status andropause dengan derajat gangguan miksi.

Hasil: Keluhan gangguan miksi derajat sedang merupakan tingkat keluhan paling umum pada responden andropause (45,5%) sedangkan keluhan ringan merupakan keluhan paling umum pada responden tidak mengalami andropause (72,2%). Hasil penelitian menunjukkan hubungan yang signifikan antara responden yang mengalami andropause dan kecenderungan mengeluhkan gejala obstruksi akibat pembesaran prostat yang dinilai melalui Skor IPSS (p=0,038).

Simpulan: Terdapat hubungan yang signifikan antara responden yang mengalami andropause dan kecenderungan mengeluhkan gejala obstruksi akibat pembesaran prostat.

Pengaruh pemberian edukasi kepada pengasuh terhadap tingkat kepatuhan pemberian obat anti epilepsi pada anak dengan epilepsi

Background: Adherence was the main problem in anti-epilepsy drug therapy because it has to be consumed up to 2 years free of seizures to require education intervention. This research aimed to analyze the effect of oral and written (leaflet) education on patient carer's adherence level in administering epilepsy medicines to the pediatric patient (?18 years old).

Methods: The design of This study was one group pre - post-test research. Subjects were collected using consecutive sampling.

Results: This study's subject was 24 patient carers with low and moderate levels of medication adherence. Oral and written education material was provided every week for eight weeks, and the adherence level was analyzed through the pills count and self-report checklist every week during the study. The Wilcoxon signed-rank test results were significantly different between pre and post-pill counts, and the result of repeated measure test showed that there was an increasing level of medication adherence significantly in third obtained by pill count method week ( p=0,000 ) and remained high until the end of this study.

Conclusion: Oral and written education could improve the caregivers administering medication adherence level to their epilepsy children.

Latar belakang: Kepatuhan merupakan masalah utama dalam terapi obat anti epilepsi karena obat anti epilepsi harus dikonsumsi sampai 2 tahun bebas kejang, sehingga diperlukan edukasi. Penelitian ini bertujuan untuk menganalisis pengaruh pemberian edukasi berupa lisan dan tertulis (leaflet) terhadap tingkat kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak usia ?18 tahun.

Metode: Rancangan penelitian ini adalah one group pre – post test design. Pengumpulan subjek dengan consecutive sampling.

Hasil: Subjek penelitian sebanyak 24 orang dengan kriteria tingkat kepatuhan rendah dan sedang. Edukasi lisan dan tertulis diberikan setiap minggu selama 8 minggu, penilaian tingkat kepatuhan melalui pill count dan self report checklist setiap minggu selama 8 minggu. Hasil uji wilcoxon signed rank terdapat perbedaan pre pill count dan post pill count, dan hasil uji repeated measure terdapat pengaruh pemberian edukasi, yang dapat dilihat dari peningkatan nilai pill count secara signifikan pada minggu ke-3 (p=0,000) dan tetap tinggi sampai akhir penelitian.

Simpulan: Pemberian edukasi berupa lisan dan tertulis memberikan pengaruh peningkatan kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak.

Clinical characteristics and demographics figures of patients with age-related macular degeneration at a tertiary-level hospital in Denpasar, Bali

Introduction: Age-Related Macular Degeneration (AMD) is a macular disease that characteristically affects the loss of central vision of the elderly. Unlike the western world, Indonesia has a relatively undocumented AMD epidemiology due to a lack of scientific attention, as indicated by few AMD publications. As a result, it is difficult to determine AMD's features and characteristics in the Indonesian population. This study aimed to evaluate AMD patients' characteristics and demographics at a tertiary hospital in Bali.

Methods: This is a Cross-Sectional study. Data were collected from medical records on Sanglah General Hospital from January 2017 until December 2019. The characteristics and features were collected and analyzed. The characteristics and demo-figure were analyzed with descriptive statistics and a Chi-square test.

Results: This study data consist of 172 patients, 90 (52.33 %) male and 82 (47.67 %) female. Most of the patients in the age group 66-83 years. The distribution of dry AMD showed the highest number on males, but the inverse occurs in wet AMD. Subjects had a smoking lifestyle in 50% of the patients. The smoking history more likely in dry AMD, but the inverse occurs in wet AMD. Hypertension occurs in more than half (51.16 %), with larger distribution in wet AMD. The proportion of gender, smoking history, hypertension but not age are significantly different between wet and dry AMD.

Conclusion: Age-related macular degeneration is a common cause of blindness in the elderly population. This study found that the prevalence of AMD increases with age. The significant factors associated with AMD were sex, hypertension and smoking habit.

Karakteristik pasien kebidanan dengan infeksi COVID-19 di Ruang Praja RSUD Wangaya Bali periode Mei - Desember 2020

Background: Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the SARS-COV2 virus. Pregnant women are important because pregnant women are more susceptible to viral infections and severe pneumonia due to physiological changes in the immune and cardiopulmonary systems during pregnancy, with manifestations ranging from asymptomatic to very severe. At this time, no research has been conducted on the local population, so that the authors will examine the characteristics of obstetric patients with COVID-19 infection in the Praja room of RSUD WANGAYA Bali. To determine the characteristics of midwifery patients with COVID-19 infection in the Praja room at Wangaya Bali Hospital for the period May 2020 - December 2020.

Methods: This study was a retrospective descriptive study using medical records from mothers related to COVID-19. The inclusion criteria were obstetric patients with COVID-19 infection in the Praja room with the results of a reactive Rapid Test or RT-PCR at Wangaya Hospital. The data collected were age, parity, screening rapid test, comorbid, probable case, clinical symptoms, laboratory results, chest x-ray, baby weight and APGAR score, type of delivery, amount of postpartum hemorrhage, confirm case with RT-PCR, length of treatment, the need for ICU rooms and the number of deaths.

Results: In this study, there were 67 respondents. Most of them were in the age range of 21-30 years and had given birth more than once. More than half of the respondents had a cesarean section, and most of the respondents tested positive for COVID-19 through the RT-PCR test. APGAR scores and baby weight were mostly normal. There were 62 respondents confirmed as RT-PCR, while with the Rapid reactive results, 66 people. Patients with mild anemia were found and found an increase in the number of CRP and neutrophils. Asymptomatic and non-comorbid patients were the most common, and on the x-ray image, most had pneumonia. There was no postpartum hemorrhage in either method of delivery. Only one person needs an ICU room. Patients infected with COVID-19 require a longer treatment time.

Conclusion: Most were found in no comorbid and asymptomatic. Laboratory results were mostly found with mild anemia, leukocytosis with neutrophilia and high NLR, and high CRP. Most pregnant women do not need ICU care.

Latar belakang: Penyakit corona virus 2019 (COVID-19) merupakan penyakit yang sangat menular yang disebabkan oleh virus SARS-COV2. Wanita hamil penting untuk diperhatikan karena wanita hamil lebih rentan terhadap infeksi virus dan pneumonia parah akibat adanya perubahan fisiologis pada sistem imun dan cardiopulmonal selama kehamilan, dengan manisfestasi dari tanpa gejala hingga sangat berat. Pada saat ini belum ada penelitian yang di lakukan pada populasi lokal, sehingga penulis akan meneliti karakteristik pasien kebidanan dengan infeksi COVID-19 di ruang Praja RSUD WANGAYA Bali. Untuk mengetahui karakteristik pasien kebidanan dengan infeksi COVID-19 di ruang Praja RSUD Wangaya Bali periode Mei 2020 - Desember 2020.

Metode: Penelitian deskriptif retrospektif dengan data catatan medik dari ibu terkait COVID-19. Kriteria inklusi merupakan pasien kebidanan dengan infeksi COVID-19 di ruang Praja dengan hasil Rapid Test atau RT-PCR reaktif di RSUD Wangaya. Data yang dikumpulkan adalah usia, paritas, skrining rapid test, komorbid, probable case, gejala klinis, hasil laboratorium, ronsen thorax, berat badan dan skor APGAR bayi, jenis persalinan, jumlah perdarahan post partum, confirm case dengan RT-PCR, lama perawatan, kebutuhan ruang rawat ICU dan jumlah yang meninggal.

Hasil: Pada penelitian ini terdapat 67 responden, sebagian besar berada dalam rentang usia 21-30 tahun dan sudah pernah melahirkan lebih dari satu kali. Lebih dari separuh responden jenis persalinannya merupakan seksio sesaria, dan sebagian besar responden positif COVID-19 melalui tes RT-PCR. Skor APGAR dan berat badan bayi sebagian besar normal. Terdapat 62 responden terkonfirmasi RT-PCR, sedangkan dengan hasil Rapid reaktif, sebanyak 66 orang. Ditemukan pasien dengan keadaan anemia ringan, serta di dapatkan adanya peningkatan jumlah CRP dan Neutrofil. Pasien tanpa gejala dan tanpa komorbid paling banyak dijumpai dan pada gambaran ronsen terbanyak mengalami pneumonia. Tidak terdapatnya perdarahan post partum pada kedua metode persalinan. Hanya 1 orang yang memerlukan ruangan ICU. Pasien terinfeksi COVID-19 memerlukan waktu perawatan yang lebih lama.

Kesimpulan: Sebagian besar ditemukan dalam tanpa kmorbid dan tanpa gejala. Hasil laboratorium sebagian besar ditemukan dengan anemia ringan, leukositosis dengan neutrofilia dan NLR tinggi, serta CRP tinggi. Sebagian besar ibu hamil tidak mebutuhkan perawatan ICU.

The prevalence between stress and acne vulgaris among medical students at Universitas Udayana in the 2019 period

Background: Acne vulgaris is a common disease in medical students. One of the causes of acne vulgaris is stress. Acne vulgaris can affect the quality of life associated with one's self-confidence. But often, this disease is ignored and not treated properly. This study aims to know if acne vulgaris occurs in students at the Faculty of Medicine, Universitas Udayana, Bali, Indonesia, related to the stress that affects acne vulgaris.

Methods: This research is a descriptive cross-sectional study. Data is collected using a data retrieval form. The inclusion criteria in this study were: 1) Participants selected must be from English class from semester 7 and aged 20 or above; 2) Participants can be from both genders; and 3) Participants that join the study willingly. Besides, the exclusion criteria were respondents who did not approve as a research sample and did not fill out informed consent. Data were analyzed using SPSS version 17 for Windows.

Results: About 62 of 93 study participants were diagnosed with acne vulgaris in students at the Faculty of Medicine, Universitas Udayana. There were 31 of 62 study participants who were diagnosed with acne vulgaris due to stress. Women had more acne vulgaris than men and the number of students that had acne vulgaris the most are at the age of 21. The most common type of lesion is comedonal with a mild classification level. Most of the subject's cause of acne due to stress is before block exam. Most of the participants feel embarrassed due to acne. About 24.2% of the subjects had a habit of scratching/squeezing acne vulgaris.

Conclusion: Most of the subjects diagnosed with acne were female and age 21 years old. Besides, comedones were the predominant type of lesion, followed by a mild degree of acne severity.

Antibiogram and biofilm formation among extended-spectrum ?-lactamase-producing Klebsiella pneumoniae clinical isolates in Sanglah General Hospital, Bali, Indonesia

Background: Klebsiella pneumoniae is a common cause of healthcare-associated infections (HAIs), and has a high level of resistance to antibiotics first, second, extended-spectrum cephalosporins, and monobactam which are a serious threat to public health worldwide. Besides, it is known that this bacterium can form biofilms as virulence factors that contribute to drug resistance. This study aims to determine the antibiotics susceptibility patterns and the capacity of K. pneumoniae to form biofilms.

Methods: K. pneumoniae was isolated from clinical specimens (urine, sputum, pus, blood, and others) for the period 2018-2019. Bacterial identification and antibiotic susceptibility testing were performed using the Vitek Compact 2 (bioMérieux®) test in the Clinical Microbiology Laboratory of Sanglah General Hospital. Biofilm formation was checked using the tissue culture plate method (TCP). Data were analyzed using SPSS version 20 for Windows.

Results: Most of Extended Spectrum ?-Lactamase (ESBL)-producing K. pneumoniae showed resistance to antibiotics. The susceptible profiles were only towards ertapenem (97.50%), meropenem (97.50%), amikacin (95.00%), and tigecycline (87.50%). The TCP method detected 72 (90.00%) as biofilm producers among 80 clinical isolates, while 8 (10.0%) as non-biofilm producers. Among the biofilm-producer bacteria, there were 6 (7.50%) as strong, 37 (46.25%) moderate, and 29 (36.25%) weak biofilm-producer isolates.

Conclusions: Most ESBL-producing K.pneumoniae clinical isolates in Sanglah General Hospital demonstrate multiple resistance to antibiotics and as biofilm producers. However, further research is needed to be conducted using a molecular approach to see the ESBL- and biofilm-encoded genes.

Perbandingan efektivitas ketorolac, deksketoprofen, dan parasetamol dalam mengurangi rasa nyeri dengan menggunakan penilaian visual analogue scale (VAS) pada pasien pasca pembedahan ortopedi ekstremitas inferior di RSUD Nganjuk, Jawa Timur, Indonesia

Background: Pain is an unpleasant emotional and subjective sensory experience which is associated with real tissue damage, potentially damaging, or describing the conditions in which the damage occurred. The use of non-steroidal anti-inflammatory drugs (NSAIDs) as an analgesic to treat postoperative pain is one of the standard therapies. This study aims to examine various types of analgesics in pain management in patients after orthopedic surgery of the inferior extremities at Nganjuk Hospital, East Java.

Methods: This cross-sectional experimental study was conducted on 15 patients after inferior limb surgery at Nganjuk Hospital in the period May 2015 - June 2015. Data on the effectiveness of ketorolac, dexketoprofen, and paracetamol in reducing pain through VAS assessment were analyzed by SPSS version 20 for Windows.

Results: Most of the men in this study (66.70%). There was a decrease in the mean VAS value between examination II (24 hours) and I (8 hours) both in the group that received ketorolac injection 30 mg/ml (3.80±0.44), dexketoprofen 50 mg/2 ml (3.00±1.00), and paracetamol 1000 mg/100 ml (2.40±5.40).

Conclusion: The results of this study indicate that the decrease in the mean VAS value as a parameter of pain was found to be greatest in the group with 30 mg / ml ketorolac injection within 24 hours.

Latar Belakang: Nyeri adalah pengalaman sensoris subjektif dan emosional yang tidak menyenangkan dimana terkait dengan kerusakan jaringan yang nyata, berpotensi merusak, atau menggambarkan kondisi terjadinya kerusakan. Penggunaan obat golongan Non-Steroid Anti Inflammatory Drugs (NSAID) sebagai analgesik untuk mengatasi nyeri pasca pembedahan merupakan salah satu standar terapi. Penelitian ini bertujuan untuk mengkaji berbagai jenis analgesik dalam manajemen nyeri pada pasien pasca pembedahan ortopedi ekstremitas inferior di RSUD Nganjuk, Jawa Timur.

Metode: Penelitian eksperimental potong-lintang ini dilakukan terhadap 15 pasien pasca bedah ekstremitas inferior di RSUD Nganjuk pada periode Mei 2015 – Juni 2015. Data tentang efektivitas ketorolac, deksketoprofen, dan parasetamol dalam mengurangi rasa nyeri melalui penilaian VAS dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Sebagian besar pada penelitian ini berjenis kelamin laki-laki (66,70%). Terdapat penurunan rerata nilai VAS antara pemeriksaan II (24 jam) dan I (8 jam) baik pada kelompok yang mendapatkan injeksi ketorolac 30 mg/ml (3,80±0,44), deksketoprofen 50 mg/2 ml (3,00±1,00), dan parasetamol 1000 mg/100 ml (2,40±5,40).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa pemberian penurunan nilai rerata VAS sebagai parameter terhadap nyeri ditemukan paling besar pada kelompok dengan injeksi ketorolac dosis 30 mg/ml dalam waktu 24 jam.

Karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I / BB Tahun 2013

Background: Uterine myoma is a benign tumor in the uterine area, or more precisely the uterine muscle and connective tissue around it. The incidence of uterine myoma is still high and increasing from year to year. This study aimed to determine the characteristics of patients with uterine myoma at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013.

Methods: This study was a descriptive study with a cross sectional approach, using medical record data at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB. The sample of this study were all patients with uterine myoma who were hospitalized at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013, as many as 115 cases. All data were analyzed descriptively.

Results: Of the 115 samples taken, 95 samples met the inclusion criteria. The results showed the distribution of the characteristics of uterine myoma patients at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013 based on the highest sociodemographic factors were aged 35-50 (84.2%), high school education (73.6%), house wives (72.6%). Based on obstetric medico factors, primipara (45.3%) was the most common. The most common symptom was abnormal bleeding (24.2%). The most common type of myoma was submucous myoma (65.3%). The most radiological examination was USG (97.9%). The most common treatment was hysterectomy (66.3%).

Conclusion: Most uterine myoma patients was at the age of 35-50 years, high school education, work as housewives, primiparous. The most common symptom was abnormal bleeding, with a submucosal myoma type. The most common treatment done was hysterectomy.

Latar belakang: Penyakit tumor jinak pada otot dan jaringan sekitar dari rahim yang masih menjadi permasalahan hingga saat ini adalah mioma uteri. Kejadian mioma uteri menunjukkan peningkatan seiring dengan waktu. Penelitian ini bertujuan untuk mengetahui karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I / BB Tahun 2013.

Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan cross sectional, menggunakan data rekam medis di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB. Sampel penelitian ini adalah seluruh penderita mioma uteri yang rawat inap di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB tahun 2013 yaitu sebanyak 115 kasus. Seluruh data dilakukan analisis deskriptif.

Hasil: Dari 115 sampel yang diambil, 95 sampel yang memenuhi kriteria inklusi. Hasil penelitian menunjukan distribusi karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB tahun 2013 berdasarkan faktor sosiodemografi tertinggi yaitu usia 35 – 50 (84,2%), pendidikan SMA (73,6%), pekerjaan Ibu rumah tangga (72,6%). Berdasarkan faktor mediko obstetri yaitu primipara (45,3%). Gejala yang terbanyak adalah perdarahan abnormal (24,2%). Jenis mioma yang terbanyak adalah mioma submukosa (65,3%). Pemeriksaan radiologi yang terbanyak adalah USG (97,9%). Penanganan yang terbanyak adalah Histerektomi (66,3%).

Simpulan: Penderita mioma uteri terbanyak pada umur 35–50 tahun, pendidikan SMA, berprofesi sebagai ibu rumah tangga, primipara. Gejala yang paling sering timbul adalah perdarahan abnormal, dengan jenis mioma submukosa, Penanganan yang paling banyak dikerjakan adalah histerektomi.

Telerehabilitation as a physical therapy solution for post-stroke patient in COVID-19 pandemic situations: a review

Background: Stroke is one of the leading causes of disability among the adult population. One-third of post-stroke patients require ongoing physical rehabilitation to improve their motoric function. But in this COVID-19 pandemic situation, all outpatient visits or non-emergency cases, including in-clinic physical rehabilitation therapy, have been postponed and limited to maintain physical distancing to prevent the spreading of infection. Telerehabilitation can be the answer to overcome this circumstance.

Methods: We conducted a comprehensive search for online literature or studies in 2020. We explored evidence using the following database Cochrane Library, PubMed, and Google Scholar. The keywords used to obtain the relevant research include “telerehabilitation” OR “telemedicine” AND “physical rehabilitation” AND “stroke patient” AND “COVID-19 pandemic”. The literature was analyzed based on the results of previous studies.

Results: Telerehabilitation delivers rehabilitation services via communication technologies involving the patient and the physical therapist communicate using telehealth platform and video-teleconference. Several telerehabilitation techniques can be used for stroke patients' physical exercise, such as portable transcutaneous electrical stimulation (TENS), mirror therapy, home exercise program, and virtual reality exercise. Several studies have shown that telerehabilitation is not inferior than in-clinic physical exercise, and both showed significant improvement in post-stroke patients' motor function.

Conclusions: Telerehabilitation can be the solution for post-stroke patient’s physical rehabilitation in the COVID-19 pandemic. This novel health innovation allowed the post-stroke patient to exercise at home and prevent them from the risk of COVID-19 infection.

Differences in union time, dash score and range of motion between giving bisphosphonate and without giving bisphosphonate of osteoporosis patients with distal radius fracture: a systematic review and meta-analysis

Background: Osteoporosis is a common health problem. Meanwhile, the incidence of distal radius fracture increases with osteoporosis. The standard modality for osteoporosis is a combination of pharmacological therapy, one example of which is the administration of bisphosphonates. There is some disagreement about bisphosphonates' effect on the treatment of distal radius fractures in osteoporosis patients. This study aims to conclude the effect of bisphosphonates for this condition on both functional and radiological outcomes

Methods: A systematic search was carried out on the PUBMED database and Google Scholar on studies comparing the timing of bone fusion, Disability of Arm, Shoulder, And Hand (DASH) scores, and wrist Range of Motion (ROM) among distal radius fracture patients with or without additional bisphosphonate therapy. A prospective or retrospective cohort study and a randomized controlled trial were included in this study during 2000-2020. Inclusion and exclusion criteria were used for sample selection. Weight Mean Difference (WMD) was used to assess the statistical results in RevMan version 5.3 for Windows.

Results: A search through the PUBMED and Google Scholar databases yielded 376 studies. Scanning titles and abstracts from studies that met the inclusion and exclusion criteria resulted in 6 articles. In total, there were 973 patients with distal radius fractures who received different treatment on bisphosphonate therapy. There was a significant difference in time to union with bisphosphonates (WMD=0.56; 95% CI=-0.94-2.06). Meanwhile, there was no significant difference in the assessment of DASH and ROM scores (WMD=0.27; 95% CI= -1.01-1.55).

Conclusion Bisphosphonates provide a slower time to union in osteoporotic patients with distal radius fracture.

Laminoplasty provides better functional outcomes than laminectomy in the management of cervical stenosis myelopathy: a systematic review

Background: Increasing the life expectancy of an individual will be accompanied by the emergence of various degenerative diseases such as cervical stenosis myelopathy (CSM). CSM is characterized by the presence of signs and symptoms of spinal cord compression associated with narrowing the spinal canal dimensions. Decompression can be achieved by conventional methods such as laminectomy or a lamina reshaping procedure known as a laminoplasty. This study reports recent evidence regarding laminectomy and laminoplasty procedures in managing CSM in terms of functional outcomes.

Methods: A systematic search was conducted on the PUBMED database to identify and find studies comparing laminoplasty and laminectomy procedures. Inclusion criteria included patients older than 65 years diagnosed with cervical myelopathy, including CSM and/or ossified posterior longitudinal ligament (OPLL). Randomized controlled studies and prospective and retrospective cohorts were included in this study, while case series and case reports were excluded. The comparison of effectiveness is based on the results of measuring functional outcomes using the Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and the visual analogue scale (VAS) for pain assessment.

Results: A thorough search through the PUBMED database yielded 156 citations. Scanning titles and abstracts from studies that met the inclusion and exclusion criteria resulted in 14 articles. All articles have a retrospective cohort design. In total, there were 187 patients in the laminoplasty group and 161 patients in the laminectomy group. There was no significant difference between laminoplasty and laminectomy when viewed from the JOA score in weighted mean difference (WMD) (WMD 0.28; 95% Confidence Interval [CI]:-0.34-0.91) and VAS score (WMD 0.06; 95% CI: -1.13-1.02). However, laminoplasty was shown to have a better NDI score (WMD 3.32; 95% CI: -6.50-0.14).

Conclusion: Laminoplasty is superior to laminectomy for managing cervical myelopathic stenosis in terms of NDI score.

Diagnosis dan manajemen pada blefaritis anterior dan posterior

Introduction: Blepharitis is a chronic inflammatory condition of the eyelid margin. Blepharitis can be distinguished based on its location, namely anterior and posterior blepharitis. Anterior blepharitis is bilateral inflammation that occurs in the area around the base of the eyelashes and on the edge of the eyelid. Anterior blepharitis generally has two main types, namely, staphylococcal blepharitis and seborrheic blepharitis. Posterior blepharitis is inflammation of the eyelid on the posterior side due to dysfunction of the meibomian gland, chronic and bilateral.

Aim: The aim of the study is to describe the comprehensive review regarding diagnosis and management of blepharitis

Conclusion: The general management used to relieve symptoms of blepharitis are warm compresses, cleaning the eyelids, including massage of the meibomian glands in cases of posterior blepharitis, antibiotic therapy (topically or systemically), topical anti-inflammatory, combination of antibiotics and topical corticosteroids, calcineuric inhibitor and Intensed Light Pulse (IPL) therapy. The treatment of blepharitis is done in combination to increase its effectiveness and get better treatment results. However, further research is still needed to select the regimen that has the highest efficacy and safety because blepharitis is a chronic disease with a high recurrence rate.

Pendahuluan: Blefaritis merupakan peradangan yang bersifat kronis atau menahun dan pada umumnya berlokasi pada tepi kelopak mata. Blefaritis dapat dibedakan berdasarkan lokasinya yaitu blefaritis anterior dan posterior. Blefaritis anterior adalah peradangan bilateral yang terjadi di daerah sekitar dasar bulu mata dan pada tepi kelopak mata. Blefaritis anterior pada umumnya memiliki dua jenis utama yaitu, blefaritis stafilokokus dan blefaritis seboroik. Blefaritis posterior adalah peradangan kelopak mata pada bagian posterior akibat disfungsi dari kelenjar meibom, bersifat kronis dan bilateral.

Tujuan: Tujuan dari tinjauan pustaka ini adalah untuk memberikan gambaran komperhensif akan diagnosis dan tatalaksanan dari bleparitis posterior.

Simpulan: Manajemen umum yang gunakan untuk meringankan gejala blefaritis adalah kompres hangat, pembersihkan kelopak mata, termasuk didalamnya adalah pemijatan pada kelenjar meibom dalam kasus blefaritis posterior, terapi antibiotika (secara topical maupun sistemik), anti inflamasi topikal, kombinasi antibiotika dan kortikosteroid topikal dan calcineuric inhibitor serta intense light pulse therapy (IPL). Penanganan blefaritis dilakukan secara kombinasi untuk meningkatkan efektifitas dan mendapatkan hasil pengobatan yang lebih baik. Namun masih diperlukan penelitian lebih lanjut guna memilih regimen yang memiliki efikasi dan keamanan yang paling tinggi karena blefaritis merupakan penyakit kronis dengan tingkat kekambuhan yang tinggi.

Infeksi COVID-19 pada pasien myasthenia gravis: sebuah tinjauan pustaka

Coronavirus disease (COVID-19) has rapidly become a global pandemic and during this condition, there might be at greater risk of exacerbation in patients with myasthenia gravis. This is related to the viral infection that has been known to increase the risk of a myasthenic crisis. In addition, some experimental drugs used in COVID-19 has been reported to increase the risk of exacerbation in patient with myasthenia gravis. In the other hand, several studies show higher morbidity and mortality rates due to COVID-19 in patient with myasthenia gravis. Myasthenia gravis might be a risk factor for severe COVID-19 infection due to several mechanisms, such as the effect of the immunosuppressive therapy and the inherent respiratory muscle weakness and vulnerabilities. The comprehensive study based on several case report is needed to respond the needs of adaptation in treating patient with myasthenia gravis during this pandemic era.

Coronavirus disease (COVID-19) telah menjadi pandemi global dalam waktu singkat. Selama pandemi ini, terdapat peningkatan resiko eksaserbasi pada pasien dengan myasthenia gravis. Hal ini terjadi karena sejak lama telah diketahui bahwa infeksi virus dapat meningkatkan resiko krisis myasthenia pada pasien myasthenia gravis. Beberapa obat eksperimental yang diberikan pada pasien dengan infeksi COVID-19 juga dilaporkan memiliki resiko yang tinggi dalam menimbulkan eksaserbasi gejala myasthenia gravis. Di sisi lain, beberapa studi terkait COVID-19 menunjukkan angka morbiditas dan mortalitas yang lebih tinggi pada pasien dengan myasthenia gravis. Myasthenia gravis juga merupakan faktor resiko untuk infeksi COVID-19 berat yang berhubungan degan beberapa mekanisme seperti efek dari terapi imunosupresan dan kondisi kelemahan otot pernafasan pada penyakit myasthenia gravis. Telaah yang komprehensif berdasarkan beberapa laporan kasus terkait infeksi COVID-19 pada pasien myasthenia gravis sangat diperlukan untuk melakukan adaptasi manajemen terapi pada era pandemi ini.

Faktor yang mempengaruhi keterlambatan pengobatan kanker payudara: sebuah tinjauan sistematik

Background: Breast cancer is cancer with a high global prevalence and high mortality rate. Several factors can affect the mortality rate and survival rate among breast cancer patients, one of which is the time it takes from diagnosis to receiving initial treatment. Delays in treatment can be caused by various factors, including patient, disease and system factors. This study aims to determine the causative factors of delay in breast cancer patients receiving treatment through a systematic review.

Method: This study is a systematic review study conducted by marshals the journals and critical appraisals of related publications from 2015-2020, published in the PubMed, Wiley Online Library and Sciencedirect database.

Results: Of the 126 related publications, an appraisal process was carried out to exclude unsuitable journals so that a total of 23 publications were analyzed in this study. Publications come from various countries, including the United States, Brazil, Mexico, Iran, China and Singapore. Based on these various literatures, it was found that the factors that could influence the delay in receiving treatment in breast cancer patients were black race, insurance ownership, low socio-economic level, low education level, lower cancer staging, and larger tumor size, indications for mastectomy surgery, the use of traditional medicines and the comorbidity of anxiety and depression.

Conclusion: Many factors cause the delay in receiving treatment in breast cancer patients. Further studies could be carried out to investigate the factors causing treatment delay in breast cancer patients.

Latar Belakang: Kanker payudara merupakan salah satu kanker dengan prevalensi global yang tinggi serta tingkat mortalitas yang tinggi. Berbagai hal dapat mempengaruhi tingkat mortalitas dan laju survival pada pasien kanker payudara, salah satunya adalah waktu yang dibutuhkan dari diagnosis hingga menerima pengobatan awal. Keterlambatan pengobatan dapat disebabkan oleh berbagai faktor diantaranya faktor pasien, penyakit serta sistem. Studi ini bertujuan untuk mengetahui faktor penyebab dari keterlambatan pasien kanker payudara dalam menerima pengobatan melalui tinjauan sistematik.

Metode: Studi ini merupakan studi tinjauan sistematik yang dilakukan dengan melakukan telaah jurnal dan critical appraisal terhadap publikasi terkait dari tahun 2015-2020 yang berada pada database PubMed, Wiley Online Library dan Sciencedirect.

Hasil: Dari 126 publikasi terkait yang ditemukan dilakukan proses appraisal untuk mengeklusi jurnal yang tidak sesuai sehingga didapatkan total 23 publikasi yang dianalisa dalam studi ini. Publikasi berasal dari berbagai negara diantaranya Amerika Serikat, Brazil, Mexico, Iran, Cina dan Singapore. Berdasarkan berbagai literatur tersebut ditemukan bahwa faktor yang dapat mempengaruhi terjadinya keterlambatan dalam menerima pengobatan pada pasien kanker payudara adalah ras kulit hitam, kepemilikan asuransi, tingkat sosial-ekonomi yang rendah, tingkat pendidikan yang rendah, staging kanker yang lebih rendah, ukuran tumor yang lebih besar, indikasi pembedahan mastektomi, penggunaan obat tradisional serta adanya komorbiditas kecemasan dan depresi.

Kesimpulan: Keterlambatan penerimaan pengobatan pada pasien kanker payudara disebabkan oleh banyak faktor. Studi lebih lanjut dapat dilakukan untuk menyelidiki faktor penyebab terjadinya keterlambatan pengobatan pada pasien kanker payudara.

Transarterial chemoembolization (TACE) in hepatocellular carcinoma BCLC B patients: case series

Introduction: Hepatocellular carcinoma (HCC) is the fifth leading cause of death for men and the seventh for women worldwide, HCC is one out of 10 most cancers in Indonesia. HCC grows in the background of chronic liver disease and often associated with hepatitis virus infection such as hepatitis B virus (HBV) and hepatitis C virus (HCV).  Transarterial chemoembolization (TACE) is a minimally invasive procedure performed by interventional radiologist as the treatment of choice for intermediate stage HCC.

Case report: Here in we report a 62 and 59 years old female with hepatocellular carcinoma Barcelona clinic liver cancer (BCLC) B who were treated with TACE using 50 mg doxorubicin mixed with Iopamiro and lipiodol. Both were patients with history of HBV infection. After 5 weeks of TACE, triphase abdominal CT-Scan was done to evaluate tumour progression, however one patient was loss to follow up.  Evaluation of one patient was done and revealed more than 30% decrease  solid viable tumour with increase of necrotic area.  Expansion of necrotic area is one of the HCC treatment response criteria, while decrease tumour enhancement explains the viability of the tumour itself.

Conclusion: TACE is the therapy of choice for patient with HCC BCLC B, which can give enlargement of necrotic area and decrease tumour viability.  

Prosedur Falsanella-Servat pada pada ptosis traumatika: laporan kasus

Background : Ptosis is a drooping or infero displacement of the upper eyelid. Traumatic Ptosis is the second most common type after acquired aponeurotic ptosis. In this case the patient with mild traumatic ptosis had no improvement for 1 year. Surgery was performed for correction of traumatc ptosis with falsanella servat procedure. The aims of case report are to know managament patient with mild traumatic ptosis who underwent surgery with falsanella-servat procedure.

Case presentation: A 18-year-old boy with dropping of left upper eyelid since 1 year ago. He had a history of hordeolum and had a curettage incision for three times. Complete opthalmology examination was perfomed on both eyes and found on right eyelid vertical palpebra fissure 12mm, horizontal palpebra fissure 35mm, levator action 18, margin limbal distance 9, margin reflect distance 4, lid crease 8, no lidlag, positive bell's phenomenon. Left eyelid examination results 8mm vertical palpebra fissure, 35mm horizontal palpebra fissure, levator action 16, margin limbal distance 7, margin reflect distance 2, lid crease 10, no lid lag, positive bell's phenomenon. Correction of traumatic ptosis with falsanella servat was performed and ptosis measurement had done after correction.

Conclusion: Surgical procedure using falsanella-servat on traumatic mild ptosis gives good contour, functional and cosmetic results.

Latar belakang: Ptosis adalah penurunan kelopak mata atas dari posisi normal. Ptosis traumatika merupakan kejadian tersering kedua setelah acquired aponeurotic ptosis. Pada kasus ini pasien dengan mild ptosis traumatika yang tidak mengalami perbaikan selama 1 tahun, dilakukan pembedahan dengan teknik operasi falsanell-servat. Tujuan dari penelitian ini adalah untuk melaporkan hasil penatalaksanaan pada pasien dengan mild ptotis traumatika yang dilakukan prosedur terapi dengan tekhnik falsanella-servat.

Laporan kasus: Pasien laki-laki 18 tahun dengan penurunan kelopak atas mata kiri sejak 1 tahun yang lalu. Pasien riwayat hordeolum pada kelopak atas mata kiri dan sempat di insisi-kuretase sebanyak 3x. Pemeriksaan mata lengkap dilakukan pada kedua mata dan didapatkan kelopak mata kanan fisura palpebra vertikal 12mm, fisura palpebra horisontal 35mm, levator action 18, margin limbal distance 9,  margin  reflect  distance  4,  lid  crease  8,  lid  lag  tidak ada,  bell’s phenomenon positif. Hasil pemeriksaan kelopak mata kiri didapatkan fisura palpebra vertikal 8mm, fisura palpebra horisontal 35mm, levator action 16, margin limbal distance 7,  margin  reflect  distance  2,  lid  crease  10,  lid  lag  tidak ada,  bell’s phenomenon positif. Pasien dilakukan perbaikan ptosis traumatika dengan tekhnik pembedahan falsanella-servat dan pengukuran ptosis setelah perbaikan.

Simpulan: Prosedur pembedahan dengan Falsanella-servat pada mild ptosis traumatika memberikan hasil yang baik dalam segi kontur, fungsi dan kosmetik.

High dose and long-term use of spironolactone induce gynecomastia in an elderly man with chronic heart failure: a case report

Introduction: Gynecomastia is caused by an imbalance of estrogen and androgen in the male breast tissue. It can be divided into three causes, physiological, drug-induced, and idiopathic. Spironolactone is a potassium-sparing diuretic that has known to pose an antiandrogen effect and can cause gynecomastia.

Case Description: A 75 years old man came for a regular cardiac examination at the hospital. He complained of tenderness and pain at his right breast for the last six months and only getting worse since the previous two weeks. He had a regular appointment with a cardiologist after diagnosed with Chronic Heart Failure Functional Class III, Suspected as Coronary Artery Disease, Hypertensive Heart Disease since January 2017. The patient regularly takes Furosemide 40 mg once a day, Clopidogrel 75 mg once a day, Valsartan 10 mg once a day, Bisoprolol 1.25 mg once a day, and Spironolactone 100 mg once a day. On physical examination, tenderness was felt on the right breast. Fine-needle aspiration cytology examination of the right breast was conducted, the finding was compatible with gynecomastia.

Conclusion: Gynecomastia is a breast enlargement in men that occurred due to hormonal imbalance and most often caused by the side effect of a high-dose and long-term use of Spironolactone. Discontinuation of the spironolactone treatment or switching to other therapy is recommended. However, gynecomastia should not be used as a reason for not prescribing Spironolactone to patients with severe heart failure.

Kondiloma akuminata perianal pada seorang laki-laki biseksual disertai infeksi HIV stadium III yang diterapi dengan kombinasi asam trikloroasetat 80% dan seng oral

Background: Condyloma acuminata in the homosexual population caused by anogenital sexual behavior causes more microabrasion to occur which increases the risk of infection with human papilloma virus (HPV) and HIV. This case report aims to provide an overview of the clinical outcome of condyloma acuminata in homosexual patients with HIV grade III.

Case: Male, 26 years old with an itchy and painless lump around the genitals and anal canal since two months ago. The new patient was diagnosed with HIV since two weeks before the visit to the Sanglah Hospital polyclinic. It was found that the patient was a homosexual with a history of multiple partners and had been going on for five years. Physical examination of the perianal region revealed multiple skin-colored tumors, geographic shape, 3x5cm - 3x5.5cm in size, with a verrucous surface, and solid consistency with a positive acetowhite test that concluded as perianal condyloma acuminata. It was decided to give tricolor acetate (TCA) 80% spotted therapy and oral zinc sulfate 100mg/day. Up to 2 TCA session therapy and oral zinc administration in approximately three weeks, the lesion was getting better with efflorescence in the form of multiple papules, color of the mucosa that confluent to form a tumor, geographic shape, size 3x2cm - 3x3cm, smooth surface, solid consistency.

Conclusion: The response to treatment with TCA 80% for 2 times and oral zinc for 3 weeks was quite good, the number of lesions was reduced and the size of the lesions was reduced. The prognosis of the patient is dubious because even if the condyloma acuminata lesion has been repaired, the presence of HIV infection can lead to the risk of recurrence and the risk of progression to malignancy.

Latar belakang: Kondiloma akuminata pada populasi homoseksual diakibatkan oleh perilaku seksual secara anogenital menyebabkan lebih banyak mikroabrasi yang terjadi yang menyebabkan peningkatan risiko infeksi human papilloma virus (HPV) dan HIV. Laporan kasus ini bertujuan untuk memberikan suatu gambaran luaran klinis dari kondiloma akuminata pada pasien homoseksual dengan HIV derajat III.

Kasus: Laki-laki, 26 tahun dengan benjolan risakan gatal dan tidak nyeri pada sekitar kelamin dan lubang anus sejak dua bulan yang lalu. Pasien baru terdiagnosa HIV sejak dua minggu sebelum kunjungan poliklinik RSUP Sanglah. Diketahui pasien merupakan seorang homoseksual dengan riwayat berganti-ganti pasangan dan sudah berlangsung selama lima tahun. Pemeriksaan fisik region perianal menunjukkan tumor sewarna kulit multipel, bentuk geografika, ukuran 3x5cm – 3x5,5cm, dengan permukaan verukosa, dan konsistensi padat dengan hasil tes acetowhite positif yang disimpulkan sebagai suatu kondiloma akuminata perianal. Diputuskan untuk memberikan terapi tutul tricolor acetat 80% dan seng sulfat oral 100mg/hari. Hingga terapi 2 kali tutul dan pemeberian seng oral dalam jangka waktu kurang lebih tiga minggu terjadi perbaikan lesi dengan efloresensi berupa papul multipel sewarna mukosa yang berkonfluen membentuk tumor, bentuk geografika, ukuran 3x2cm – 3x3cm, permukaan licin, konsistensi padat.

Simpulan: Respon pengobatan dengan TCA 80% selama 2 kali dan seng oral selama 3 minggu cukup baik, jumlah lesi berkurang dan ukuran lesi mengecil. Prognosis dari pasien adalah dubius karena walaupun telah terjadi perbaikan lesi kondiloma akuminata, adanya infeksi HIV dapat menyebabkan risiko terjadinya rekurensi dan risiko perkembangan ke arah keganasan.

Nodular anterior scleritis in systemic sclerosis: a case report

Introduction: Scleritis is an inflammation of the sclera’s lining, characterized by cellular infiltration, collagen damage, and vascular changes. The incidence rate of scleritis accompanied by systemic disease generally is around 39% to 50%. Scleritis can be divided into two, namely anterior and posterior scleritis. Anterior scleritis can be divided into four, diffuse anterior scleritis, nodular anterior scleritis, necrotizing anterior scleritis with inflammation and without inflammation. One of the causes of nodular anterior scleritis is systemic sclerosis which is an autoimmune disease. Nodular anterior scleritis in systemic sclerosis is very rare, with an estimated prevalence rate of 4.4%.

Case Description: A man, 46 years old, complaining of red, watery, painful, and visible white membrane on his right eye since two weeks ago and was referred from an ophthalmologist with scleritis on his right eye. The patient had a history of asthma and cataract surgery. Physical examination showed right eye VA was 6/45 pinhole (PH) 6/18, conjunctival and scleral injection, nodule on superior conjunctiva with yellowish-white in color. Laboratory examination showed a clinical representation of autoimmune disease, consulted to the rheumatology division, and was diagnosed with systemic sclerosis. The patient has been prescribed corticosteroids and immunosuppressant’s for the therapy, the patient's eye condition improves after.

Conclusion: Systemic sclerosis with a presenting ophthalmologic complaint is a rare disease. This case illustrates that nodular anterior scleritis needs comprehensive intervention to seek the etiology and provide the treatment. This case has shown that nodular anterior scleritis with systemic sclerosis improved with corticosteroids and immunosuppressants, a typical treatment for autoimmune disease.

Refractive lens exchange on keratoconus patient: a case report

Introduction. Keratoconus is a vision disorder that occurs when the cornea becomes thin and irregularly (cone) shaped. Instead of being focused correctly on the retina, this abnormal shape causes the light entering the eye to improperly refracted and manifested as a distortion of vision. Refractive Lens Exchange is one type of Invasive therapy in Keratoconus. Here we describe a case of Keratoconus managed by the Refractive Lens Exchange procedure in our Center.

Case Description. A male, 25 years old, visited the clinic due to blurry vision since ten years ago. Every six months or a year, he needs to adjust his lens power. Ophthalmology examination found visual acuity in the right eye was 2/60 PH 6/60, and if using S-9.00, visual acuity improved to 6/30. Meanwhile, visual acuity in the left eye was 1/60 PH 6/60 and if using S–11.75, visual acuity improved to 6/48. Corneal topography supports the finding of Keratoconus. Management for this patient was Refractive Lens Exchange + Intraocular Lens + Capsular Tension Ring. Initially, This  advised was differ from the patient expectation, as he wanted a LASIK procedure. An important reminder was given, that Keratoconus is contraindicated for LASIK and any corneal surface ablation procedure. After series of procedure, the VA of the right eye was 6/15 PH 6/6, with C - 4.00 x 180⁰ VA became 6/6. VA left eye was 6/18 PH 6/9, with C - 4,00 x 180⁰ VA became 6/9. Binocular vision was 6/6. For near vision, S +3.00 was added for both eyes.

Conclusions. Refractive Lens Exchange + Intraocular lens implantation is effective and safe procedures to treat high myopia in keratoconus cornea.

Management of pregnant women with Refractory Immune Thrombocytopenia Purpura (ITP) receiving eltrombopag therapy at Sanjiwani Hospital, Gianyar, Indonesia

Background: Immune Thrombocytopenia Purpura (ITP) is an autoimmune disease characterized by a low level of platelets in the blood caused by accelerated platelet destruction or disruption of the thrombopoiesis due to antibodies to platelets. Drugs with similar functions to thrombopoietins (TPO) such as eltrombopag and romiplostim have been widely used and have been shown to be quite successful in treating ITP in nonpregnant patients. This case study aims to evaluate eltrombopag therapy's role in managing the refractory ITP in pregnant women.

Case Presentation: A 25-year-old patient, a housewife, presented to the obstetrics clinic at Sanjiwani Hospital for the first time at a gestational age of 13 weeks for her third pregnancy, with a history of two abortions. ITP was diagnosed in 2017 during the second abortion treatment. The platelet examination results were between 32,000-66,000/?l, with platelet count during delivery planning at 34 weeks of 41,000/?l. The patient was diagnosed with chronic refractory ITP and was considered for second-line drug administration. Intravenous Immunoglobulin Therapy (IVIG) and anti-D administration as second-line drugs were not possible due to cost. The patient was given 50 mg eltrombopag per day for a week. The platelet counts increased to 202,000/?l a week after therapy. The patient then underwent vaginal delivery with a baby weight of 2,850 gram, Apgar Score of 8-10. The baby was exclusively breastfed and subjected to clinical monitoring and laboratory tests. The patient's clinical condition was favorable and the platelets fell to 20,000/?l nineteen days after delivery.

Conclusion: In this case, the patient with chronic ITP refractory to steroid therapy showed an immediate response to eltrombopag. However, the platelet level decreased two weeks after the treatment cessation. More studies are needed on the use of eltrombopag in pregnant women.

Dramatic improvement in severe-critical COVID-19 patient after tocilizumab administration: a clinical experience

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in coronavirus disease 2019 (COVID-19) involve so many inflammatory cytokines, especially Interleukin-6 (IL-6). The usage of tocilizumab as an anti-IL-6 receptor antibody had been approved as COVID-19 medication.

Case Presentation: This article reports a 51-year-old woman diagnosed with severe-critical COVID-19. The patient made significant progress after tocilizumab administration. The patient was hospitalized for 14 days before being discharged.

Conclusion: Tocilizumab administration showed a significant improvement in COVID-19 patients.  However, further investigations are needed to explain this further.

Introduction: Pores are openings of the sebaceous gland on the skin’s surface that secrete oil, acting as the skin’s lubricant and protection. Pores can appear tiny funnel-shaped structures found on most of the body but most commonly seen on the face. Fac

Introduction: Pores are openings of the sebaceous gland on the skin’s surface that secrete oil, acting as the skin’s lubricant and protection. Pores can appear tiny funnel-shaped structures found on most of the body but most commonly seen on the face. Facial enlarged pores can be a cosmetic problem, especially for women. There are various factors involved in developing enlarged facial pores. However, sebum production and facial skin’s elasticity are the main factors. Botulinum toxin type A injection can reduce enlarged pore with three mechanisms. Therefore, there are inhibit acetylcholine, reducing sebaceous follicles glands, paralyzing the muscular erector pilli, reducing sebum secretion, and assuming increasing collagen.

Case: The following reported two cases with grade 6 enlarged facial pores in a 38-year-old man and a 35-year-old woman. Patients have been given Botulinum Toxin A injection therapy with intradermal small bolus injection of botulinum toxin in one-time therapy and evaluated after four weeks of therapy. At the fourth week of evaluation of the first patient, there was a decrease in facial enlarged pores’ severity from 6 to 3 and a decrease in the sebum score from 3 to 1. Whereas in the second case, the pores severity degree decreased from 5 to 3, and the sebum score decreased from 3 to 2.  Dermoscopy examination before and after therapy showed reduced pore size.

Conclusion: Botulinum toxin type A intradermal injection is effective in reducing sebum production and facial pore size.

Pendahuluan: Pori-pori merupakan lubang dari kelenjar sebaceous pada permukaan kulit yang mengeluarkan minyak yang berfungsi sebagai pelumas dan perlindungan kulit. Pori-pori dapat tampak sebagai struktur berbentuk corong kecil yang dapat ditemukan pada hampir seluruh tubuh tetapi paling sering tampak pada wajah. Facial enlarged pore dapat menjadi masalah kosmetik terutama bagi wanita. Berbagai macam faktor dilaporkan dapat terlibat dalam perkembangan facial enlarged pore, tetapi produksi sebum dan elastisitas kulit wajah merupakan faktor yang paling sering berperan. Injeksi botulinum toksin tipe A memiliki mekanisme kerja menurunkan facial enlarged pore dengan menghambat asetilkolin sehingga menurunkan aktivitas kelenjar folikel sebaceous, melumpuhkan musculus arector pilli sehingga mengurangi sekresi sebum, dan meningkatkan kolagen.

Kasus: Berikut ini dilaporkan dua buah kasus facial enlarged pore pada wajah dengan tingkat derajat 6 pada laki-laki berusia 38 tahun dan wanita berusia 35 tahun. Pasien diberikan terapi menggunakan injeksi Botulinum Toxin A metode multiple intradermal small bolus injection of botulinum toxin selama 1 kali terapi dan dilakukan evaluasi hingga 4 minggu terapi. Evaluasi pada minggu ke-4 pada pasien pertama didapatkan penurunan derajat keparahan facial enlarged pore dari 6 ke 3 dan penurunan skor sebum dari 3 ke 1. Sedangkan pada kasus kedua didapatkan penurunan derajat keparahan pori-pori dari 5 ke 3 dan penurunan skor sebum dari 3 ke 2. Pemeriksaan dermoskopi pada sebelum dan sesudah terapi memperlihatkan ukuran pori-pori menurun.

Simpulan: Injeksi intradermal botulinum toksin tipe A dinilai efektif dalam menurunkan produksi sebum dan ukuran pori-pori wajah.